Vaccine-preventable illness

As a pediatric emergency medicine provider in a state with a high proportions of vaccine-refusers, I often treat vaccine-preventable infections. This week was no exception, with one of the cases particularly severe.

A New York Times piece reminds us that vaccine refusal is most prevalent in white, higher income regions. The lowering of herd immunity in clusters like this allows vaccine preventable diseases to spread to the unimmunized as well as to their vulnerable neighbors–people too young for vaccines or immune compromised through cancer or other conditions.

The vaccine risk-benefit numbers are among the best in medical science and yet still many patients and families don’t believe the science. The most common reactions I hear in these cases are “I had no idea this disease could be so bad” and “I thought you could just wipe out the infection with medicine.”

The first reaction demonstrates one issue contributing to vaccine refusal: that vaccines are a victim of their own success. Thanks to vaccines, most have not seen or known people who experienced vaccine-preventable diseases, and thus the benefit of vaccination seems remote. One exception is influenza–the most common vaccine-preventable killer in our country–as those who suffer the greatest risk of death are at the extremes of age, pregnant women, the very obese and the medically frail. This is also the most common vaccine-preventable illness I treat, and the cause of the most vaccine-preventable deaths in my clinical setting.

Here is where I hear the most of the second reaction–the realization that antiviral medications, like oseltamivir, can help reduce the risk of influenza-related death, but not eliminate the risk completely. Many on the list of vaccine-preventable illnesses–such as measles, tetanus and polio–have no antimicrobial treatments, just supportive care. For others on the list–including influenza, pertussis, epiglottitis and meningitis–antimicrobials can improve outcomes, but not eliminate risk once the patient has the illness. One reason these conditions were targeted for vaccination development is precisely because they are both dangerous and difficult to treat–prevention is essential to reducing mortality. This is a similar scenario for cancer, as a recent commentary notes, but financial pressures incentivize pharmaceutical companies to focus on treatment rather than prevention.